Early and intermediate age-related macular degeneration: update and clinical review

Abstract

Age-related macular degeneration (AMD) is the leading cause of irreversible central vision loss in developed countries. With the aging of population, AMD will become globally an increasingly important and prevalent disease worldwide. It is a complex disease whose etiology is associated with both genetic and environmental risk factors. An extensive decline in the quality of life and progressive need of daily living assistance resulting from AMD among those most severely affected highlights the essential role of preventive strategies, particularly advising patients to quit smoking. In addition, maintaining a healthy diet, controlling other risk factors (such as hypertension, obesity, and atherosclerosis), and the use of nutritional supplements (antioxidants) are recommendable. Genetic testing may be especially important in patients with a family history of AMD. Recently, unifying criteria for the clinical classification of AMD, defining no apparent aging changes; normal aging changes; and early, intermediate, and late AMD stages, are of value in predicting AMD risk of progression and in establishing recommendations for the diagnosis, therapeutic approach, and follow-up of patients. The present review is focused on early and intermediate AMD and presents a description of the clinical characteristics and ophthalmological findings for these stages, together with algorithms for the diagnosis and management of patients, which are easily applicable in daily clinical practice.

Bioactive lipids and pathological retinal angiogenesis

“…The early stage of AMD is characterized by accumulation of drusen, underneath the RPE (Garcia‐Layana et al ., ) followed by progression to the advanced stages with geographic atrophy and choroidal neovascularization (CNV). The pathological features of geographic atrophy include gradual loss of RPE cells, photoreceptors and the choriocapillaris (Holz et al ., ).…”

Thyroid dysfunction as a modifiable risk factor for age-related macular degeneration: A case-control investigation

“…The diagnosis of AMD largely depends upon fundus examination with dilated pupils as well as con rmatory optical coherence topography (OCT) and uorescein angiography where applicable. As such and in clinical practice, individuals with visual problems including decreased vision, central visual eld defect or metamorphopsia would need to be referred to an ophthalmologist to have ruled-out AMD [6]. While aging, white race, having fair colored irises, and obesity are among well-described risk factors for AMD, the contributing role of factors such as gender and hypertension in the prevalence of AMD has remained controversial across studies [7].…”

Current Practice in Low Vision Rehabilitation of Age-related Macular Degeneration and Usefulness of Virtual Reality as a Rehabilitation Tool

“…As the leading cause of acquired visual impairment in the Western world, AMD is responsible for 8.7% of all blindness worldwide. In individuals aged 65 to 75 years, AMD prevalence ranges between 9%-25%, and over 80% of those affected become legally blind after age 70 [1][2][3][4][5][6][7][8]. In France, AMD affects 8% of the population, and its frequency increases with age: 1% of people aged 50 to 55 years, 10% of those 65 to 75 years, and 25% to 30% of persons aged over 75 suffer from AMD [1,6,[9][10][11].…”

“…As individuals lose their central vision and the ability to discriminate between fine spatial details, they become less autonomous in performing basic activities of daily living (ADLs, e.g., walking, feeding, dressing) as well as instrumental activities of daily living (IADLs, e.g., taking medications, independent mobility, managing money). This predisposes them to low self-esteem and it is correlated with a three times greater risk of developing depression [3,[5][6][7][8][9][10]. Additionally, AMD patients are twice as likely to fall and four times more likely to fracture a hip [4,6,7,9,[10][11][12][13][14][15][16][17][18].…”